ABSTRACT
A self psychological approach is defined by the use, as a compass, of sustained and often effortful attention to the patient’s subjective perspective and the careful tracking of the predominantly unconscious selfobject transference demands made by the patient on the therapist. Our understanding of impediments to the therapist’s empathy (and patient’s empathy) is as meaningful in a treatment as is the understanding of resistances to evenly hovering attention or free association. A self psychological approach tracks micro ruptures and repairs in selfobject functions as well as in empathic understanding. In Heinz Kohut’s view, we are driven by our ambitions and desires for recognition, led by our ideals and values, and seek a sense of belonging with others to create, maintain or restore self-continuity, coherence and wellbeing. If these developmental needs are traumatically disrupted, individuals search for others whose primary importance to them is to create, maintain or restore these requirements for an enlivened and stable self. Recognition of the different subjectivity of another, including the therapist, is impaired when a self is unstable, threatened by shame and easily enraged. We illustrate these concepts with clinical material.
